Thai rescue: How to help the boys survive months in a cave

Twelve boys and their football coach have been found alive in a cave in Thailand, after being missing for nine days. But the group may need to stay in the cave up until October, when the flood waters that stranded them there are expected to subside. The boys and their coach are likely to face extreme physical and psychological challenges while they wait.

Are they all okay?

According to Narongsak Ostanakorn, governor of the local Chiang Rai region, none of them are in critical condition, but some may have injuries. They have now been given a supply of painkillers, plus antibiotics as a preventative measure.

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What are their most urgent needs?

Survival in extreme conditions depends on access to a few key resources: oxygen, stable and habitable temperatures, water, and food – in that order, according to Mike Tipton, a physiologist at the University of Portsmouth, UK. “If you can tick the first boxes, you’re looking at weeks of survival. In any survival situation, you just go through that hierarchy,” says Tipton.

To have got this far, the cave likely has a decent supply of oxygen and an adequate temperature. According to some reports, the group survived by drinking water that dripped from limestone in the cave, but now that divers have made contact with them, they can be provided with supplies of drinking water and food.

What type of food will they need?

It’s possible to go without food for up to several weeks, but the trapped boys may need to stay in the cave for much longer than that. Divers have now given them some food, and authorities will be thinking carefully about what best to give the group in coming weeks.

“General survival rations tend to be high on fat and sugar,” says Tipton. Large amounts of protein are generally to be avoided. “When you eat protein, it accentuates dehydration,” he says.

How can they maintain their natural body clocks in darkness?

Disruptions to the body’s natural circadian rhythms can take a large toll on a person’s health. Our 24-hour cycles are kept in sync through exposure to light, so precautions will need to be taken to help the group maintain their circadian rhythms – it’s no coincidence that early experiments on circadian rhythms were done in caves.

But light isn’t the only factor – you can re-establish circadian rhythms by having set periods of time in between meals, says Tipton.

How will they be rescued?

Authorities are faced with a tough decision about the best method to rescue those who are trapped. One possible route out of the cave could be for the group to scuba dive their way out – but the almost mile-long tunnels make this unlikely, especially for beginners. Heavy rain rushing into the cave’s tunnels last week generated strong currents, putting diving almost out of the question. “Trying to take non-divers through a cave is one of the most dangerous situations possible, even if the dives are relatively easy,” says Anmar Mirza, coordinator of the US National Cave Rescue Commission.

A preferable option may be to wait for the flooding to ease – which could take several months – and providing the group with survival supplies until then. But this won’t necessarily be easy either. “Supplying them on site may face challenges depending on how difficult the dives are,” says Mirza.

Will there be mental health effects?

David Paterson, a physiologist at the University of Oxford, says that the key challenges faced by the group will be psychological. “Because they’re living in a confined space, with no natural light, that will clearly affect them. Being mentally resilient is going to be critical,” says Paterson.

Paterson compares the conditions in the cave to the isolation experienced by astronauts. Studies of astronaut morale suggest that maintaining good communication with the group, being honest about the situation, and helping them to stick to day-night cycles will help maintain morale. Helping the boys keep occupied is also a good idea, and any surprise communications with their families or gifts in their supplies are likely to help boost their mood while they wait.

Are they safe to remain in the cave until October?

Possibly not. More rain is forecast and if the water rises further, this may endanger the dry area the group is in, or possibly cut them off from divers and supply packages. There is talk from ministers in Bangkok about trying to rescue the group before that happens.